For lower back, time is as good a healer as surgery, says new study

People with ruptured disks in their lower backs usually recover whether or not they have surgery, researchers are reporting today.

People with ruptured disks in their lower backs usually recover whether or not they have surgery, researchers are reporting today. The study, a large trial, found that surgery appeared to relieve pain more quickly but that most people recovered eventually and that there was no harm in waiting. And that, surgeons said, is likely to change medical practice.

The study, published in The Journal of the American Medical Association, is the only large and well-designed trial to compare surgery for sciatica with waiting.

The study was controversial from the start, with many surgeons saying they knew that the operation worked and that it would be unethical for their patients to participate in such a study. In the end, though, neither waiting nor surgery was a clear winner, and most patients could safely decide what to do based on personal preference and level of pain. Although many patients did not stay with their assigned treatment, most fared well with whatever treatment they had.

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Patients who had surgery often reported immediate relief. But by three to six months, patients in both groups reported marked improvement. After two years, about 70 percent of the patients in the two groups said they had a “major improvement” in their symptoms. No one who waited had serious consequences, and no one who had surgery had a disastrous result.

Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded. “I think this will have an impact,” said Dr Steven R Garfin, chairman of the department of orthopaedic surgery at the University of California, San Diego. “It says you don’t have to rush in for surgery. Time is usually your ally, not your enemy,” Dr Garfin added.

Sciatica is characterized by an often agonizing pain in the buttocks or leg or weakness in a leg. It is caused when a ruptured disk impinges on the root of the sciatic nerve, which runs down the back of the leg. Patients are often told that if they delay surgery they may risk permanent nerve damage, perhaps a weakened leg or even losing bowel or bladder control. But nothing like that occurred in the two-year study comparing surgery with waiting in nearly 2,000 patients.

The study did not include people who had just lower back pain. Nor did it include people with conditions that would require immediate surgery like losing bowel or bladder control. Instead, they were typical of a vast majority of people with sciatica who are made miserable by searing pain. For such patients, fear that delaying an operation could be dangerous “was the 800-pound gorilla in the room,” said Dr Eugene J Carragee, professor of orthopaedic surgery at Stanford.

–GINA KOLATA